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BMC Psychiatry
Published in: BMC Psychiatry 1/2017

Open Access 01-12-2017 | Research article

The comparative effectiveness and efficiency of cognitive behaviour therapy and generic counselling in the treatment of depression: evidence from the 2nd UK National Audit of psychological therapies

Authors: Jo Pybis, David Saxon, Andy Hill, Michael Barkham

Published in: BMC Psychiatry | Issue 1/2017

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Abstract

Background

Cognitive Behaviour Therapy (CBT) is the front-line psychological intervention for step 3 within UK psychological therapy services. Counselling is recommended only when other interventions have failed and its effectiveness has been questioned.

Method

A secondary data analysis was conducted of data collected from 33,243 patients across 103 Improving Access to Psychological Therapies (IAPT) services as part of the second round of the National Audit of Psychological Therapies (NAPT). Initial analysis considered levels of pre-post therapy effect sizes (ESs) and reliable improvement (RI) and reliable and clinically significant improvement (RCSI). Multilevel modelling was used to model predictors of outcome, namely patient pre-post change on PHQ-9 scores at last therapy session.

Results

Counselling received more referrals from patients experiencing moderate to severe depression than CBT. For patients scoring above the clinical cut-off on the PHQ-9 at intake, the pre-post ES (95% CI) for CBT was 1.59 (1.58, 1.62) with 46.6% making RCSI criteria and for counselling the pre-post ES was 1.55 (1.52, 1.59) with 44.3% of patients meeting RCSI criteria. Multilevel modelling revealed a significant site effect of 1.8%, while therapy type was not a predictor of outcome. A significant interaction was found between the number of sessions attended and therapy type, with patients attending fewer sessions on average for counselling [M = 7.5 (5.54) sessions and a median (IQR) of 6 (3–10)] than CBT [M = 8.9 (6.34) sessions and a median (IQR) of 7 (4–12)]. Only where patients had 18 or 20 sessions was CBT significantly more effective than counselling, with recovery rates (95% CIs) of 62.2% (57.1, 66.9) and 62.4% (56.5, 68.0) respectively, compared with 44.4% (32.7, 56.6) and 42.6% (30.0, 55.9) for counselling. Counselling was significantly more effective at two sessions with a recovery rate of 34.9% (31.9, 37.9) compared with 22.2% (20.5, 24.0) for CBT.

Conclusions

Outcomes for counselling and CBT in the treatment of depression were comparable. Research efforts should focus on factors other than therapy type that may influence outcomes, namely the inherent variability between services, and adopt multilevel modelling as the given analytic approach in order to capture the naturally nested nature of the implementation and delivery of psychological therapies. It is of concern that half of all patients, regardless of type of intervention, did not show reliable improvement.
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Literature
1.
Layard R, Clark D, Bell S, Knapp M, Meacher B, Priebe S, et al. The depression report: a new deal for depression and anxiety disorders. London School of Economics: The Centre for Economic Performance’s Mental Health Policy Group; 2006.
2.
3.
4.
5.
Propst LR, Ostrom R, Watkins P, Dean T, Mashburn D. Comparative efficacy of religious and nonreligious cognitive–behavioral therapy for the treatment of clinical depression in religious individuals. J Consult Clin Psychol. 2002;60:94–103.CrossRef
6.
Cuijpers P, Driessen E, Hollon SD, van Oppen P, Barth J, Andersson G. The efficacy of non-directive supportive therapy for adult depression: a meta-analysis. Clin Psychol Rev. 2012;32:280–91.
7.
Cuijpers P, Straten A, Andersson G, Oppen PC. Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol. 2008;76:909–22. doi:10.​1037/​a0013075.CrossRefPubMed
8.
Cape J, Whittington C, Buszewicz M, Wallace P, Underwood L. Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Med. 2010;8:38.
9.
Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman ATF, Reynolds CF. The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry. 2013;12:137–48. doi:10.​1002/​wps.​20038.CrossRefPubMedPubMedCentral
10.
Ward E, King M, Lloyd M, Bower P, Sibbald B, Farrelly S, et al. Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: Clinical Effectiveness. Brit Med J. 2000;321:1383–8.
11.
King M, Marston L, Bower P. Comparison of non-directive counselling and cognitive behaviour therapy for patients presenting in general practice with an ICD-10 depressive episode: a randomized control trial. Psychol Med. 2014;44:1835–44.
12.
MacPherson H, Richmond S, Bland, Brealey S, Gabe R, Hopton A, et al. Acupuncture and counselling for depression in primary Care: a randomised controlled trial. PLoS Med. 2013;10:e1001518.
13.
Sanders P, Hill A. Counselling for depression. A person-centred and experiential approach to practice. Sage; 2014.
14.
Pearce P, Sewell R, Hill A, Coles H, Pybis J, Hunt J, et al. Counselling for depression: the perceptions of trainees. Healthc Couns Psychother J. 2013:8–13.
15.
16.
17.
18.
19.
Glover G, Webb M, Evison F. Improving access to psychological therapies: a review of the progress made by sites in the first roll-out year. 2010.
20.
21.
Evans C, Margison F, Barkham M. The contribution of reliable and clinically significant change methods to evidence-based mental health. Evid Based Ment Health. 1998;1:70–2.CrossRef
22.
23.
24.
Snijders TAB, Bosker RJ. Multilevel analysis: an introduction to basic and advanced multilevel modelling. 2nd ed. London: Sage Publishers; 2012.
25.
Rasbash J, Charlton C, Browne WJ, Healy M, Cameron B. MLwiN Version 2.1. Centre for Multilevel Modelling, University of Bristol; 2009.
26.
Department for Health. Which talking therapy for depression? A guide to understanding the different psychological therapies you may be offered to treat your depression n.d.
27.
28.
29.
Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.
30.
IBM Corp. Released 2013. IBM SPSS statistics for windows, version 22.0. Armonk, NY: IBM Corp.
31.
Rasbash J, Steele F, Browne WJ, Goldstein H. A user’s guide to MLwiN, v2.26. Centre for Multilevel Modelling, University of Bristol; 2012.
32.
Stiles WB, Barkham M, Mellor-Clark J, Connell J. Effectiveness of cognitive-behavioural, person-centred, and psychodynamic therapies in UK primary-care routine practice: replication in a larger sample. Psychol Med.2008;38:677–88.
33.
Browne WJ MCMC estimation in MLwiN Version 2.13. Centre for Multilevel Modelling, University of Bristol; 2009.
34.
Driesson E, Hollon SD, Cuijpers P, Dekker JJM. Does pretreatment severity moderate the efficacy of psychological treatment of adult outpatient depression? A meta-analysis. J Consult Clin Psychol. 2010;78:668–80.
35.
Saxon D, Ashley K, Bishop-Edwards L, Connell J, Harrison P, Ohlsen S, et al. A pragmatic randomised controlled trial assessing the non-inferiority of counselling for depression versus cognitive-behaviour therapy for patients in primary care meeting a diagnosis of moderate or severe depression (PRaCTICED): study protocol for a randomised controlled trial. Trials.2017;18:93.
36.
Kim DM, Wampold B, Bolt DM. Therapist effects in psychotherapy: a random-effects modeling of the National Institute of Mental Health Treatment of Depression Collaborative Research Program data. Psychother Res. 2006;16:161–72.
37.
Okiishi JC, Lambert MJ, Eggett D, Nielson L, Dayton DD, Vermeersch DA. An analysis of therapist treatment effects: Towards providing feedback to individual therapists on their clients’ psychotherapy outcome. J Consult Clin Psychol. 2006;62:1157–72.CrossRef
38.
Saxon D, Firth N, Barkham M. The relationship between therapist effects and therapy delivery factors: therapy modality, dosage, and non-completion. Adm Policy Ment Health. First Online: 16 July 2016. doi:10.​1007/​s10488-016-0750-5.
39.
Garfield SL. Research on client variables in psychotherapy. In AE Bergin & SL Garfield (Eds.), Handbook of psychotherapy and behavior change. 4th ed. New York: Wiley; 1994. p. 190–228.
40.
Ostler K, Thompson C, Kinmonth AL, Peveler RC, Stevens L, Stevens A. Influence of socio-economic deprivation on the prevalence and outcome of depression in primary care: the Hampshire depression project. Br J Psychiatry. 2001;178:12–7.CrossRefPubMed
41.
Luborsky LML, Diguer AT, Woody L, Seligman G, DA. The psychotherapist matters: comparison of outcomes across twenty-two therapists and seven patient samples. Clin Psychol Sci Pract. 1997;4:53–65.CrossRef
42.
Saxon D, Barkham M. Patterns of therapist variability: therapist effects and the contribution of patient severity and risk. J Consult Clin Psychol. 2012;80:535–46.CrossRefPubMed
Metadata
Title
The comparative effectiveness and efficiency of cognitive behaviour therapy and generic counselling in the treatment of depression: evidence from the 2nd UK National Audit of psychological therapies
Authors
Jo Pybis
David Saxon
Andy Hill
Michael Barkham
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1370-7

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